CTRI Blog

Depression – 2 Key Insights for Helpers

The word depression gets thrown around a lot. Socially, the word has become an overused synonym for sad, annoyed, frustrated, or simply disappointed. People often make offhanded comments like “I am so depressed that sweater hasn’t gone on sale,” which shows little thought or regard for those who bear the true weight of the word. The flippancy of its use can distract from the intensity of the lived reality of depression and can undermine those who have an intimate connection to it.

The reality of depression is that it is often all-consuming. It can steal the joy out of things once loved by the sufferer, alter perception of self and others, and at its worst, manipulate a person into planning for the relief anticipated from death. Depression is calculating, vindictive, and strategic. It thrives when left unattended and unmanaged.

From the clinician’s perspective, working with depression can be a working contradiction. It can be exhausting, overwhelming, while also incredibly rewarding. It is exhausting as clients struggle to make progress and suffer setbacks along the way. It can be overwhelming due to the initiative and impetus it takes to stay positive and motivated under the powerful energy influence that depression brings with it. It can be very rewarding when signs emerge to show that the cloud is potentially lifting and progress is looking more sustainable. Working with depression requires as much a commitment from the clinician as is needed from the client, and sometimes more.
From working with many people living with or struggling with either a formal diagnosis of depression or identified depression related symptoms, I have been able to identify two key areas essential to successful interventions.

The strength of the relationship between counsellor and client, also known as the therapeutic alliance

AND

The intentional application of 5 guiding principles.

The strength of the relationship between counsellor and client, also known as the therapeutic alliance refers to the counselor’s ability to stay connected, regulated, optimistic, and motivational. This is of utmost importance, particularly as it relates to creating an energy in opposition to the powerful and often paralyzing energy of depression. Being able to formulate a plan, collaboratively execute intervention efforts, modify and adapt strategies as needed, all while maintaining motivation throughout the process are necessities of any effective helper’s skill set and critical to the counsellor client connection. In many cases, the only one in the room who can see the color filled pathway out of the black and white life of depression is the counselor. Tapping in and out of an intervention plan, either in energy or in effectiveness will undermine the therapeutic connection and simply is not an option for an effective counselling relationship.

The intentional application of 5 guiding principles refers to the counsellor’s ability to identify, explore and apply the following guiding principles, while also being able to articulate their relevance to the client. This not only reinforces the therapeutic alliance but also serves as a powerful springboard to purposeful interventions and identifiable outcomes.

1. Make the mind/body connection.Address persistent cognitive distortions and self-deprecating thinking patterns that aggravate and reinforce depression symptoms and behaviors. This also includes tending to and using the body through movement to work against depression.2. Distinguish depression from the depressed. Recognize when depression is overruling an individual’s ability to intake, generate, process, and/or apply information and strategies. This may include having the “is it time to have a conversation with your doctor about medication” conversation.3. Ignite hope in the face of hopelessness. Empathize, normalize, and capitalize on the counselor’s effect to generate the necessary engagement needed to implement thinking and behavior change strategies.4. Motivate the unmotivated.Develop strategies for increasing behavioral change in the face of what can be chronic emotional and physical pain.5. Build positive social connections by building connection capacity. Explore social isolation as both a cause and symptom of depression. Identify the influence of negative social experiences and the necessity of positive relationships for healing.

Connection in the therapeutic alliance, capacity in the application of the guiding principles, and a commitment to simultaneously building on both has become my tried and true foundational recipe for working with individuals living with depression.

This blog is a sample from an upcoming book CTRI is publishing titled Counselling Insights: Practical Strategies for Helping Others with Anxiety, Trauma, Grief, and more…. This book will be released January 2018. For more information please visit ACHIEVE Publishing.

As a counsellor and as someone who has struggled with depression I can honestly say that the ultimate source of healing is in the body. CBT feels diminishing…like you have ‘faulty’ thinking = you are faulty. This feeling of being entirely faulty is the crux of the issue. It is deep shame that keeps a person ‘depressed.’ I agree with your intention number one (mind/body). I believe however, far too many counsellors rely on mind over body as a technique. I am curious as to what kinds of movement you suggest in therapy. In my experience (with deep shame and a feeling of not feeling safe), the notion of somatic modalities is the first order, not the add on to the cognitive approaches. These approaches do not hit the source…they add to shame unfortunately. %100 it is worth supporting a clients ability to identify thinking that is not helpful but it remains inadequate without settling the body, ANS and creating safety. When asked by a wonderful counsellor I was seeing, to do a week long ‘though watch,’ that accompanied anxiety I was able to identify when the thoughts resulted from the physiological, when certain thoughts added on to that physiological experience and being able to separate them in addition to see how they collaborated to keep me ‘safe.’ So thoughts actually originate from our deepest bodily sensations….then we can work with those thoughts that are not so helpful. Once the body feels safe….the thoughts change to naturally being helpful.
I love your number 5 intention, as working with a supportive counsellor in exploring ways to lean into positive experiences and identify those that are not so helpful was very very forward moving. It worked largely because I knew the brain research on this…negative bias and how to, bit by bit, counteract this natural tendency. And that brings me to normalizing and empathizing, especially normalizing. Teaching a depressed person how our neurophysiology works and how we can help ourselves, takes away the shame of feeling faulty and allows the techniques in as a welcome reprieve from ‘thinking’ that we are faulty somehow. And that allows kindness towards ourselves which is fundamental for guiding us to better and better mental health.
Thanks for your article.

Jenn L

Thank you for this. <3

Lynn Thier

I had a suicide attempt at 15, on many medications for over 28 years and in therapy… What worked for me was outside the box techniques such as Time Line Therapy(R), Hypnotherapy and NLP Techniques, that work with our unconscious mind where everything is stored…. I’ve worked in social services and health and fitness for over 25 years, after doing this for myself and learning it, i’m now as a Trainer and Master NLP Practitioner, my clients get fast results. Hoping people in therapy will expand their minds to other modalities, expand awareness to add resources to their toolkit.